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Faculty of Health Sciences

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Subject: search.filters.subject.Forward head posture

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    The effects of an upper cervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture
    (2023-05-31) Petzer, Matthew; Abdul-Rasheed, Ashura
    Background: Postural dysfunction in the cervico-thoracic spine often leads to segmental restrictions and hypomobility, and this is often caused by biomechanical alterations due to postural changes and over activity of skeletal muscles in that region. These muscles include the pectoralis and trapezius muscles. Postural dysfunction and joint restrictions are often treated by manual therapies, such as spinal manipulation. Previous studies have established that joint manipulation reduces postural dysfunction and improves joint mobility, which could be explained by a combination of neurophysiological,and biomechanical effects.In literature, the immediate benefitsof acervico-thoracicmanipulation on muscleactivityandposture are not well understood and, therefore, an investigation into the immediate effects of manipulation on muscle activity and posture was implemented in this study. Aim: This study aimed to observe the immediate effect of an uppercervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture. Methods: This study was a quantitative, observational study with a pre-test posttest design. Surface electromyography was used to measure the muscle activity of the pectoralis major, upper and middle trapezius muscles prior to and after the cervico-thoracic intervention. A sample size of 40 asymptomatic participants were recruited to participate. The participants were randomly divided into two groups: group A, which was the control group, and group B, which was the intervention group. The intervention group received a cervico-thoracic manipulation, but the control group received no intervention and remained prone for 3 minutes between the pre-test and post-test readings. The within-group comparisons of pre- and postmuscleactivity were achieved usingpairedT-tests. Within groupandbetween group comparisonsof the change between pre- andpost-intervention wereachieved using repeated ANOVA testing. A p-value below 0.05 was statistically significant. IBM Statistical Package for Social Sciences (SPSS) version 26 software was used to process the data. Results: There was no statistically significant treatment effect of cervico-thoracic spinal manipulation in the effects on muscle activity. Although there was not a statistically significant change in muscle activity, there was a positive change in pectoralis major compared to the upper or middle trapezius. The upper and middle trapezius muscles decrease activity followed an evident trend between the participants who received the intervention compared to the control group. Postural results were not statistically significant but positive correlations to treatment were found. The craniovertebral angle was seen to decrease at a higher rate compared to the control group. Additionally, the study provided evidence of a treatment effect on the acromiovertebral angle, decreasing overall in severity. Conclusion: The results of this study do not provide conclusive evidence that the intervention has any immediate statistical effect on the three muscle activity measurements outcomes observed. In terms of the Posture Pro Analysis System measurements, changes (decrease in angles) between the pre- and postintervention were mostly significant in both groups, but statistically there was no difference between the control and intervention groups. Posture Pro ratings did not provide evidence of changes in categories within the groups. Therefore, the null hypothesis was retained.
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    Normal craniovertebral angle range in asymptomatic Black South African females : a pilot study
    (2022-09-29) Antony, Reenu; Varatharajullu, Desiree; Venketsamy, Yomika
    Introduction: Forward head posture (FHP) has become more prevalent in modern times and is described as carrying the head anterior to the centre of the shoulder. As the head moves forward, the centre of gravity shifts. To compensate for this shift, the upper body shifts backward to maintain balance, which eventually leads to fatigue and subsequent myofascial pain when this position is maintained for prolonged periods of time. The craniovertebral angle (CVA) measures the degree of FHP and is formed between a horizontal line passing through C7 of the cervical spine and a line extending from the tragus of the ear to C7 spinous process. Previous studies have concluded that a smaller CVA indicates FHP. Global studies have reported possible associations between FHP and postural related musculoskeletal complaints and chronic pain especially in Black females in South Africa. Studies have also reported various therapies that would increase CVA, thus correcting or improving FHP to manage or prevent the negative impacts associated with FHP. Normal cervical spine radiographic parameters may differ in males and females, and among the various South African ethnic groups, suggesting that normal CVA ranges may also differ among the sexes and various ethnic groups. A generally accepted normal CVA range to accurately measure and quantify FHP warrants the need to determine a standardised and normalised range for CVA for Black females in South Africa, so as to a set reference point for clinical practice and research. Aim: The aim of this study was to determine a normalised range for CVA among Black South African females to be utilised for further studies and clinical practice. Method: This was a pilot study that used a quantitative, non-experimental, observational design. Black South African females between the ages of 18 and 45 years were recruited through advertisements placed in and around the Durban University of Technology and greater Durban area and via word of mouth. A total of 51 participants were recruited. Symptomatic participants and participants who presented with FHP on visual assessment were excluded from the study. Markers were placed at the tragus of the ear and at C7 spinous process. Lateral photographs were taken with a digital camera of the participants in seated and standing positions. The Posture Pro Software Analysis was used to measure CVA from the photographs obtained. The data captured were sent to a statistician for statistical analysis. Results: The mean CVA while seated was 41.88 degrees, with a standard deviation of 5.23; and the mean CVA while standing was 37.15 degrees, with a standard deviation of 4.30. The paired t-test result showed a significant difference between CVA in seated and standing position (p < 0.001). Furthermore, the correlation between BMI and CVA seated and standing had a significant weak positive correlation of 0.320 (p<0.05) and 0.391 (p<0.01) respectively. Conclusion: The results indicated that CVA differs significantly between the seated and standing position and that CVA in the seated position was more increased when compared to the standing position.
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    An investigation into the role of forward head posture as an associated factor in the presentation of episodic tension-type and cervicogenic headaches
    (2010) Duani, Victor; De Busser, Nikki Lauren; Nell, Jacob
    Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache.